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Most fibromyalgia patients are exhausted all the time and suffer from painful muscles and joints. But these aren’t the only common symptoms of fibromyalgia — at least one fourth of fibromyalgia patients also have some form of depression. In fact, adult fibromyalgia patients are much more likely than those without fibromyalgia to be depressed.

The link between fibromyalgia symptoms and depression makes sense. First, coping with the severe pain and fatigue of fibromyalgia can be frustrating and disruptive to your lifestyle. And fibromyalgia symptoms can also lead you through unchartered territory as you work through a maze of health care providers.

How Depression Can Make Fibromyalgia Symptoms Worse

Like other people with depression, fibromyalgia patients often experience a loss of interest in their favorite activities and feel lonely, tired, and sad.

“Depression makes pain worse and causes lots of fatigue and functional disability in fibromyalgia patients,” says Roland Staud, MD, professor of medicine, division of rheumatology and clinical immunology at the University of Florida in Gainesville. There is a strong correlation, Dr. Staud says, between pain and depression: “Alleviation of one leads to alleviation of the other.”

Elizabeth W. Carson, PhD, a clinical psychologist on staff at St. Joseph’s Hospital in Atlanta, Ga., says she sees many fibromyalgia patients who are depressed as well as frustrated with their disease process. “Depression makes the patient more aware of the pain of fibromyalgia.”

While depression may be common in fibromyalgia patients, Staud says it is not common for people with fibromyalgia to be substance abusers. In fact, “There is no empirical evidence of substance abuse in fibromyalgia patients,” Staud says.

Fibromyalgia and Depression Therapy Option 1: Antidepressants

“There is no analgesic [pain reliever] to jointly treat pain and mood disorders,” says Staud. However, antidepressants are often used to treat fibromyalgia symptoms, with or without the presence of depression.

Two classes of antidepressants used to treat fibromyalgia symptoms are selective serotonin reuptake inhibitors (SSRIs) and combined serotonin and norepinephrine reuptake inhibitors (SNRIs). “SNRIs are more effective for treating both depression and fibromyalgia symptoms,” says Staud. “SSRIs have a lesser effect on fibromyalgia symptoms.” SNRIs include Effexor (venlafaxine) and Cymbalta (duloxetine). Examples of SSRIs include Celexa (citalopram) and Prozac (fluoxetine).

Staud also recommends cognitive behavioral therapy for fibromyalgia patients who are dealing with depression. For fibromyalgia patients, the goal of cognitive behavioral therapy is to change how you think about pain and in turn change how you deal with the pain.

Carson says she uses this therapy to address negative thinking. “By retraining patterns of thinking, you can help the patient change his or her behavior and how they deal with their fibromyalgia.”

Fibromyalgia and Depression Therapy Option 3: Counseling

Counseling, another type of psychological therapy, can take place in group sessions, in which patients meet with a therapist and exchange experiences and ideas, or as one-on-one discussions with a therapist.

During these group or individual sessions, patients discover strategies for coping with pain or tackling other issues related to depression and fibromyalgia symptoms. “Group therapy is more economical and helps, but individual therapy is more effective,” says Staud.

Fibromyalgia and Depression Therapy Option 4: Self-Help

“Depression is a form of exhaustion,” says Carson. “With fibromyalgia, sleep is fragmented by pain, and circadian rhythms are disturbed.”

Getting into a regular routine of sleep and performing daily activities can help re-establish healthy circadian rhythms. “Sleep hygiene is really important in treating depression associated with fibromyalgia,” adds Carson.

Additionally, exercise such as walking, jogging, and riding a bike may benefit patients with depression. Exercise can help people feel better both physically and mentally.

Fibromyalgia and Depression Therapy Option 5: Easing Pain and Fatigue

Addressing the underlying fibromyalgia symptoms such as pain and fatigue may also help to relieve depression. Several prescription medicines are now available to treat fibromyalgia pain symptoms, including Lyrica (pregabalin) and Savella (milnacipran). Non-narcotic pain relievers such as tramadol are also prescribed for fibromyalgia pain.

By working with your doctor to find the right fibromyalgia therapy, you’ll be able to target all your fibromyalgia symptoms, including depression.